Treating the Different Types of Hematomas

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A hematoma (also called a contusion or bruise) refers to an abnormal collection of blood in the body that is typically the result of a broken or ruptured blood vessel. Hematomas can cause a minor skin bruise, or a collection of clotted blood that is deep within a muscle, organ, or even the skull.

Superficial Hematomas and Muscle Contusions

Hematomas near the skin results in a large patch of skin discoloration (typically black and blue) that occurs after trauma to the soft tissue. A bruise develops when small blood vessels beneath the skin rupture and blood leaks into the soft tissue beneath the skin.

Muscle contusions can happen when you are struck by an object or have a fall, and the muscle tissue is crushed without breaking the skin. The pool of blood in the muscle can form a lump in the area of the damage.

Hematomas cause pain, swelling, and tenderness over the area of skin discoloration or deep within the body. A large hematoma may last weeks to months and as it heals it will change color and slowly shrink in size.

Treating a superficial hematoma is similar to the treatment used for other soft tissue injuries. Using the R.I.C.E method is recommended. Apply ice to the area for 15 minutes, several times per day. Mild hematomas and contusions typically heal within about five days. For large hematomas, a doctor may drain it surgically to help it heal faster.

Intracranial Hematomas Affecting the Skull and Brain

Head injuries can lead to hematomas that affect the brain. Head injuries in sports should always be treated with serious concern that it could result in a traumatic brain injury. Any loss of consciousness, however brief, needs follow-up with a health care provider. If you suspect a head injury but don't see any initial signs or symptoms, you should still follow the head injury first aid treatment steps. Signs for intracranial hematomas include headache, vomiting, drowsiness, dizziness, confusion, slurring of speech and unequal pupil size. These may be immediately after a blow to the head, or they can appear hours to days or even weeks later.

Epidural Hematoma

A more serious hematoma is an epidural hematoma, also called an extradural hematoma, in which a blood vessel in the head ruptures, often due to a skull fracture, and bleeding occurs between the skull and the brain's protective covering (the dura). This clot can grow either slowly or rapidly and it puts pressure on the brain that, if not treated promptly, can result in coma or death. It is seen in skull fractures in children and adolescents because their dura is not as firmly attached to the skull. Proper use of helmets in sports and recreational activities such as skiing and cycling aims to prevent this sort of injury.

Subdural Hematoma

In a subdural hematoma, the bleeding occurs from the veins on the surface of the brain and collects between the surface of the brain and the dura that covers the brain. It can occur in a serious head injury, but it may also occur in minor head injuries in people who are elderly, taking anticoagulant medications, abusing alcohol or have clotting problems. As with an epidural hematoma, immediate follow-up and treatment are needed to prevent compression of the brain tissue, coma, and death.

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Article Sources

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  • Subdural hematoma, MedlinePlus, U.S. National Library of Medicine, 7/27/2014.
  • Epidural hematoma, MedlinePlus, U.S. National Library of Medicine, 9/3/2014.
  • Intracranial hematoma, Mayo Clinic, June 25, 2014.

  • Muscle Contusion (Bruise), OrthoInfo, American Academy of Orthopaedic Surgeons, March, 2014.